Research concerning the effects of migrants on elder care in affluent receiving countries has been substantial, but we know little about the effects of migrant care on elder care in sending countries. There also is limited research on elder care in the context of the return migration of migrant care workers. This theoretical article explores the potential relevance of a social network perspective, which views individuals and countries as being interconnected even when they are miles apart. A multi-level framework that considers macro-, meso- and micro-level perspectives is introduced to better account for current migrant care arrangements. The macro-level perspective takes into account country-level characteristics including policies, geography and cultural preferences; the meso-level perspective takes into account the characteristics of the entire network, which may spread over different countries; and the micro-level perspective concerns the unique characteristics of the individuals who make up the network. This approach proposes that the effects of migrant home care go way beyond the care recipient–care-giver dyads or triads to incorporate many individuals and countries that are transnationally interconnected via the work of care. This article also aims to increase public and scientific awareness to the potential impact of migrant care and return migration on elder care in the sending countries by stressing a transnational social network perspective.

Previous studies indicate that occupation might affect cognitive functioning in late life. As people in low- and middle-income countries often have to work until late life, we sought to investigate if there are cognitive benefits to working later into life and whether cognitive function deteriorates after exiting the labour force. We analysed longitudinal data from the Mexican Health and Aging Study (MHAS), a nationally representative sample of Mexican adults age 50+ (N = 7,375), that assessed cognitive functioning by verbal learning, delayed recall and visual scanning. Analyses were carried out using mixed-effects modelling corrected for the influence of gender, instrumental activities of daily living, diabetes, stroke, hypertension, depression, income and marital status. Results suggest that working actively, compared to exiting the workforce, was associated with cognitive performance only in context with occupation. Domestic workers had a faster decline in verbal learning (b = −0.02, p = 0.020) and delayed recall (b = −0.02, p = 0.036) if they continued working actively and people working in administration (b = 0.03, p = 0.007), sales (b = 0.02, p = 0.044) and educators (b = 0.03, p = 0.049) had a slower decline in visual scanning if they continued working in old age. Our findings indicate that continued participation in the labour force in old age does not necessarily come with cognitive benefits. Whether or not working actively in later life protects or even harms cognitive functioning is likely to depend on the type of job.

Urban population ageing has significant implications for city centres catering for an increasing number of older consumers. To guide world cities on taking action in response to population ageing, the World Health Organization (WHO) has addressed the universal features of the age-friendly city. This study applies the WHO guideline to the context of shopping. With an emphasis on older consumers, the perceptions of the city centre as a physical and social shopping environment are studied. Using a qualitative content analysis, older consumers’ perceptions (focus-group participants aged 64–94) are analysed based on the age-friendly city features. The perceptions are compared with those of younger consumers (qualitative-survey respondents aged 21–41). The study confirms the significance of older city shoppers, and suggests their needs and wants should be taken into account in urban development projects. The older consumers differ from younger consumers in their city-shopping behaviour and perceptions in many respects. The age groups highlighted the same themes, but mainly with dissimilar content. This indicates that measures to develop a city centre friendlier to older consumers also benefit their younger counterparts, but for different reasons. It is necessary to understand this disparity to create a city-centre shopping environment that is friendly for different ages. The study offers new perspectives on responding to the challenges that consumer ageing poses to Western cities.

Older people now currently drink alcohol more frequently than previous generations, indicating a need to understand how this influences health and wellbeing in older adults. However, knowledge and awareness of the changing role alcohol plays in the lives of older people is not necessarily widely understood by allied health professionals in acute hospital contexts. In turn, conversations about drinking alcohol in later life may not be routinely addressed as part of practice, limiting an older person's choice to make informed decisions about their drinking. This paper qualitatively examines when occupational therapists (N = 17) in an acute hospital setting will initiate a conversation with older people (65+ years) about their drinking, guided by a theoretical lens that encompasses both person-centredness and collective occupation. Adopting a qualitative methodology, this study illustrates a typology of reasoning describing how, and in what circumstances, therapists ask older people about their alcohol use. Three themes were generated that provide further insight into the typology, these being ‘hesitancy in practice’, ‘failure to link life transitions to alcohol use’ and ‘challenges of focusing on healthfulness’. These findings provide a potentially useful tool for therapists, services and organisations to self-assess their approach to asking older people about alcohol use; a necessary element of professional health-care practice as social trends in alcohol use continue to increase.

Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.

The population aged 65 years and above in Hong Kong is projected to rise from 15 per cent in 2014 to 38.4 per cent in 2069. Therefore, the quest for creating age-friendly conditions and the promotion of active ageing has become a priority for the Hong Kong Government and stakeholders in the city. Using a cross-national comparative framework for productive engagement in later life, this article examines the predictors of productive engagement (perceived voluntary engagement) in two districts (the Islands and Tsuen Wan) of Hong Kong – a typical productivist welfare regime in Asia. Data were collected through a social survey to ascertain the perception of an age-friendly city and active ageing in 2016 and 2018 from 1,638 persons aged 60 years and older. The results indicate some differences in the perception of the key determinants in both districts, but the factors associated with productive engagement were consistent, namely social atmosphere, social provisions and the built environment. The findings are discussed within the broader discourse on social gerontology, age-friendly cities and productivist welfare regimes.

Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.

Research regarding quality of life among older people has predominantly focused on functional elements experienced at individual or dyadic level despite the complex interplay of factors that contribute to quality of life. Perspectives which explore interdependencies within communities and the intersecting environments in which older people exercise agency have seen less study. They do, however, play an important role in influencing quality of life as experienced by older people across community settings. Qualitative data from a co-produced study of dimensions influencing quality of life in older people was subjected to secondary analysis using a critical human ecological approach. Findings demonstrate the importance of community interdependencies in supporting individual quality of life, the expression of active agency to foster quality of life within and across communities, and the importance of state infrastructures and service provision within these interdependencies. This article argues for a movement beyond functional conceptualisations of quality of life towards the inclusion of perspectives regarding communal wellbeing, alongside the role differing types of community play in influencing quality of life. Through developing conceptions of quality of life in social relations and community cohesion, in particular how quality of life is influenced by perceptions of solidarity and social justice including across generations, assessing quality of life at community level will assist in driving cultural change in policy making and practice.

Age-related hearing loss (ARHL) is common and a known risk factor for social disengagement in later life. This study explored social functioning following a diagnosis of ARHL. Using a constructivist grounded theory approach we developed an interview schedule to advance a grounded theory from data collected from six older adults who used either hearing aids or cochlear implants. Interview questions concerned social functioning as well as focusing on their perspective of the impact of ARHL on cognitive functioning. We describe a grounded theory conceived as ‘Reconnecting to Others’. This theory posits that participants faced social challenges in relation to their ARHL, and resolved these challenges partly through the use of hearing aids and cochlear implantation. The theory also emphasises the importance of help from other hearing aid users for new users, and corroborates prior findings about strategies older adults with ARHL use to cope with their hearing impairment in various social situations. Once hearing aids and cochlear implants are used and adapted to with the help of peers, participants completed their journey by helping others who had received diagnoses of ARHL. Additionally, participants spoke of the pleasure of hearing again. Interestingly, no participant felt that their ARHL had impacted their cognitive functioning. Our theory provides a basis for explaining existing quantitative findings as well as creating new hypotheses for future testing.

Earlier studies show that experiencing life as meaningful in old age promotes holistic wellbeing and health among older people. As more and more people are living with reduced capacities in their own homes, there is an urgent need to find new ways of promoting holistic wellbeing of the ageing population. Analysing data gathered from existential discussion groups on Service TV (STV), we show how strongly relationality and meaning in life are intertwined for older people. Our findings indicate that respect and support for the autonomy of older people is very important: in order to continue living at home, and prepare for a future with reduced capacities, they need family members for support. Autonomy of ageing becomes relational as choices and wishes are negotiated with family members. Relationships also contribute to loss of meaning. When older people felt that they were not close enough to their family, longed for friends of the same age, were bereaved or widowed, the relational gap caused a violation of meaning. In contrast, participation and activities with peers brought deep joy and connectedness to the lives of the participants. STV provided a new channel for participants to find and form meaningful relationships. Therefore, it is concluded that relationality can be supported by technological means of care.

We carried out a narrative review and thematic analysis of literature on the physical health care, mental health care and social care of trans older adults to ascertain what is known about older trans adults’ contacts with and use of health and social care. Thirty papers were found: a majority originated in the United States of America. Five themes were identified: experience of discrimination/prejudice and disrespect; health inequalities; socio-economic inequalities; positive practice; and staff training and education. The first three themes present challenges for providers and service users. Experiences of discrimination/prejudice and disrespect over the course of their lives powerfully influence how older trans adults engage with care services and practitioners. Health and socio-economic inequalities suggest that older trans adults are likely to have greater need of services and care. The remaining two themes offer opportunities for service improvement. We conclude that more research is needed, that there is a strong argument for taking a lifecourse perspective in a spirit of cultural humility, and that contextual societal factors influence service users and providers. We identify positive trans-inclusive practices which we commend to services. More needs to be done now to make older adult services appropriate and welcoming for trans service users.

Older adults’ mental health problems are a growing public health concern, especially because their rate of mental health service use is particularly low. Decades of mental health service utilisation models have been developed, yet key assumptions from these models focus primarily on factors that facilitate or inhibit access into the treatment system without taking into considering the dynamics of how individuals respond to their mental health problems and engage in service utilisation. More recently, dynamic models like the Network Episode Model (NEM-II) have been developed to challenge the underlying, rational choice assumption of traditional utilisation models. Given the multifaceted and complex nature of older adults’ mental health problems, the objective of this study was to examine whether the NEM-II is a helpful and appropriate model for understanding the dynamic process of how older adults navigate the mental health system, including factors that advanced and delayed help-seeking. Our qualitative analyses from 15 interviews with older adults revealed that their backgrounds, social supports and treatment systems influence, and are influenced by, their illness careers. Factors that delayed help-seeking included: a lack of support, ‘inappropriate’ referrals/advice from treatment professionals and poor mental health literacy. This research suggests the NEM-II is a helpful and appropriate theory for understanding older adults’ pathways to treatment, and has implications to enhance older adults’ access to psychological services.

The purpose of this paper is to provide an understanding of why people are still retiring earlier than would have been expected, despite policies that increase the retirement age. This is a qualitative study in a large public-service organisation in Sweden focusing particularly on how human resource routines aimed at middle management tend to inhibit the promotion of a prolonged working life, despite government efforts aimed at changing these actions. The results highlight three key routines (development talks, salary talks and internal recruitment) that inhibit prolonged working life. These routines seem rational and appropriate to the organisation's managers, because the demands of the job must have priority over employees’ capabilities in recruitment routines. Furthermore, it could be considered economically rational to prioritise salary demands of younger employees over those of older employees, and it may appear economically rational to stop further training efforts for older employees. In general, then, it seems reasonable to managers to make decisions based on objective criteria like age. Nevertheless, our results suggest that these routines may need to be redesigned in order to support a prolonged working life and to avoid a discrepancy between accepted prolonged working-life policies and the actions of organisational actors. The study further reveals how intra-organisational institutions (e.g. taken-for-granted mind-sets and norms) embedded in human resource routines may promote or inhibit prolonged working life, suggesting a need for change in those institutions.

Due to urbanisation in China, about 7.74 million older people have migrated to urban centres, where their adult children reside and work, to care for their grandchildren. While older migrants may benefit from family reunion and mutual support, empirical studies have identified challenges to adaptation, integration and mental health. Employing a systematic literature review approach, this paper examines recent empirical studies on the mental health of older migrants migrating along with adult children in China, focusing on mental health and wellbeing outcomes and determinants and directions for social work interventions. It identifies directions for considering diversity in conceptualisations of mental health and in theoretical perspectives to enrich understanding of the experiences of Chinese older migrants migrating along with adult children and potential interventions.

Life expectancy in China has increased. This paper explores the age when older adults (aged 60 and above) consider themselves to be an ‘older person’ and how age-related loss of resources (five dimensions: early cumulative factors, decline and loss of health resources, reduction and loss of economic resources, weakening and loss of social support resources, and personal role transition and experiences of losing family members) could impact their perceived old age. Using two waves of data from the China Longitudinal Ageing Social Survey (CLASS) in 2014 and 2016 (6,244 participants in 2014 and 2,989 participants in both 2014 and 2016), we found that the mean perceived old age is around 70 years at baseline (2014). Higher level of educational attainment and occupational types (early cumulative factors), better health condition, receiving support from friends and taking care of grandchildren are significantly associated with the perception that old age begins at an older age at baseline, while being Han-Chinese, being an urban resident (early cumulative factors) and reporting better health condition have significant positive effects on the perception that old age begins at an older age in the later wave. Our findings suggest that the age standard of older adults should be adjusted dynamically in response to social development and longevity, and also highlight the importance of early cumulative factors in shaping the ageing process besides age-related factors.

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.

This paper reports on a study which examined the notions of authenticity and citizenship for people living with cognitive impairment or dementia in a care home in the North-East of England. We demonstrated that both notions were present and were encouraged by engagement with an artist, where this involved audio and visual recordings and the creation of a film. The artist's interactions were observed by a non-participant observer using ethnographic techniques, including interviews with the residents, their families and the staff of the care home. The data were analysed using grounded theory and the constant comparative method of qualitative analysis. Our findings suggest that participatory art might help to maintain and encourage authenticity and citizenship in people living with dementia in a care home. Certainly, authenticity and citizenship are notions worth pursuing in the context of dementia generally, but especially in care homes.

Inefficient health service utilisation puts pressure on health systems and may cause such negative individual consequences as over-medicalisation or exacerbation of health problems. While previous research has considered the key relevance of health literacy (HL) for efficient use of health services, the results of that research have been somewhat inconclusive. Possible reasons for diverging results of prior research may be grounded in different measurement concepts of HL and the disregarding of age-specific effects. This paper analyses the association between individuals’ HL typology based on a two-dimensional concept and indicators of health service utilisation measured by registered data covering the number of doctor visits and medication costs. Our results confirm a significant interaction effect between age and HL typology. The age-related increase in health service utilisation is strongest for individuals with the combination of high subjective HL but low health-related knowledge, while the smallest increase is for individuals with the constellation of high subjective HL combined with high health-related knowledge. Individuals with specific constellations of HL (that is, individuals with high subjective HL but low health-related knowledge) are associated with reduced service utilisation in younger ages but higher service utilisation in later stages of life, compared to other groups. These results are likely to be attributed to a higher external health-related locus of control and more traditional paternalistic role expectations in such groups.

Retirement timing can have important health implications. Little is known, however, about older adults’ views on this issue and whether they consider it better to retire later, earlier, on time or anytime. This knowledge gap about older adults’ views is particularly true outside North America and Europe. This qualitative study aims to examine older Chileans’ ideas about the relationship between retirement timing and health and to explore gender and class patterns in qualitative themes identified, knowledge which may strengthen quantitative population-based approaches. Framework analysis was conducted on qualitative accounts from a purposive, non-random sample of 40 older Chileans in six focus groups, stratified by gender and class as marked by lifetime occupation. Transcriptions were coded by two independent reviewers (inter-coder reliability = 81%) according to four deductive categories of retirement timing as well as inductive coding of emergent themes. The content and sequence of codes were visually represented in MAXQDA's document portraits and illustrated with descriptive quotes. Results indicate that participants’ views about when to retire in order to maximise health did not highlight retirement age or timing (later, earlier, on time, anytime). Instead, these older Chileans emphasised that the optimal retirement age depends on other conditions, such as employment quality, retirement income and gender. These views were patterned: lower occupational-class participants emphasised income and job hazards, higher-class males emphasised job satisfaction and higher-class females emphasised gendered patterns. Women and lower-class participants were relatively more favourable to earlier retirements than men and higher-class participants. Overall, qualitative analyses of lay perspectives from understudied country contexts complement and extend population-based models focused on timing or retirement age, suggest specific characteristics of retirement transitions that may moderate health consequences, and highlight class and gender differences in views of retirement timing. More research is needed using mixed-methods approaches and leveraging both purposive and random samples.

For some older people and their families, live-in care offers a way of continuing to live independently at home in their local community. While research in the care industry has consistently highlighted the effects of caring on workers, little research has specifically explored the experiences of live-in carers. The current study examines the ways in which live-in carers construct their role, the different challenges they face and the strategies they use to mitigate them. Semi-structured interviews were carried out with 21 live-in carers in the United Kingdom and the data were analysed using thematic analysis. The findings suggest that carers perceive their role as complex and characterised by a heavy workload and tiredness. Participants emphasised the variability which was introduced to the role as a function of the quality of agency support, the character and condition of the client, and the carer's relationships with the client's family. Participants’ accounts reflected an acknowledgement of the need to orient and respond constantly to the needs and routine of the client. While this orientation was recognised as necessary for effectively fulfilling the demands of the role, it was also linked to feelings of dislocation and loss of identity. Drawing on understandings of personal and social identity, the implications of these findings for the psychological wellbeing of live-in carers and organisational support are discussed.